Cathlab workers are at greater risk for certain health problems due to radiation exposure.
Study leader Maria Grazia Andreassi, PhD, head of the Genetics and Molecular Epidemiology Unit at the National Research Council Institute of Clinical Physiology in Pisa, Italy, and colleagues publish their findings in the journal Circulation: Cardiovascular Interventions.
Fluoroscopy is a form of medical imaging that uses a continuous X-ray beam to see real-time images of certain parts of the body.
The technique is used for a number of heart procedures, including coronary angiography – used to detect heart conditions – and coronary artery angioplasty – used to widen blocked or narrowed arteries.
Such procedures are normally conducted in a hospital’s cardiac catheterization (cath) lab.
Cardiologists, electrophysiologists have greatest radiation exposure
A number of medical staff in cath labs are exposed to fluoroscopy radiation, including doctors, nurses and technicians. Andreassi notes that, of all X-ray procedures, fluoroscopy-guided heart procedures lead to the greatest radiation exposure among health care workers.
“Interventional cardiologists and electrophysiologists have a two to three times higher annual exposure than that of radiologists, as they are closer to the radiological source and experience radiation exposure with the patient, whereas diagnostic radiologists are generally shielded from radiation exposure,” she explains.
Andreassi says that busy cardiologists and electrophysiologists are exposed to around 5 millisieverts (mSv) of radiation each year; mSv is a measure of how much radiation is absorbed by the human body.
This means that over a 30-year career, these health care workers may be exposed to around 50-200 mSv – the equivalent of 2,500-10,000 chest X-rays. But how does such exposure affect health? Andreassi and her team set out to investigate.
Cath lab workers at greater risk for health problems
The researchers assessed the results of an Italian survey that was completed by 746 health care workers. Of these, 466 worked in cardiac cath labs for a median of 10 years, while 280 worked in non-radiation health care settings.
- In fluoroscopy, an X-ray beam is passed through the body and the image is shown on a fluorescent screen
- The patient is given a contrast agent in order to make their organs visible on the screen
- Fluoroscopy exposes the patient to ionizing radiation, with doses dependent on the procedure being performed.
Compared with health care workers who did not work in cath labs, those who did were found to be at 7.1 times greater risk for back, neck or knee problems, 6.3 times greater risk for cataracts and 2.8 times greater risk for skin lesions.
The results accounted for subjects’ smoking habits and other influential factors.
As expected, the estimated radiation exposure was highest for cardiologists and electrophysiologists.
Individuals who had worked in a cath lab for at least 16 years were found to have the highest risk for such conditions, and these workers were also found to be at three times higher risk for developing cancer than those who worked in other health care settings.
Still, the team notes that previous studies have associated chronic radiation exposure with poor long-term heart health.
More focus on radiation protection needed
The researchers point to a number of study limitations. Radiation doses were self-reported by health care professionals rather than being measured, for example.
Additionally, the workers themselves decided whether they wanted to take part in the survey, and the team notes that if they had pre-existing health conditions, they may have been more motivated to do so.
While the study is unable to establish cause and effect between radiation exposure and health problems, the researchers believe their findings emphasize the need for increased focus on protecting the health of medical professionals regularly exposed to radiation – particularly cardiologists and electrophysiologists.
Andreassi notes that intensive training in how to protect against radiation can significantly reduce exposure in the workplace.
“Unfortunately, cardiologists pay little heed to monthly or cumulative reports of radiation exposure,” she adds. “And recent studies confirm that simple, effective protection measures – such as a lead curtain, protection glasses and thyroid collars – are not used by the majority of exposed cardiologists.”